RelaÃÃo dos achados endoscÃpicos e dopplerfluxomÃtricos na colopatia da hipertensÃo porta da esquistossomose mansÃnica: estudo longitudinal

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

The relationship between colonoscopic features, histopathologic changes and Doppler ultrasound measurements in colonic mucosal, in patients with hepatosplenic schistosomiasis, before and after splenectomy and ligature of the left gastric vein was analysed. The study was performed using colonoscopy and Doppler ultrasonography. Sixteen patients were divided into groups. Group It0 â preoperative-11 patients (mean age of 22Â11 years); group It1- postoperative-6 months-10 patients; group It2- postoperative-2 years- 6 patients and group II- postoperative- 10 years follow-up - 5 patients (mean age 23.2Â2.7 years). There was reduction of the portal vein diameter: t0 vs t1 â 1.19Â0.23 vs 0.95Â0.21mm (p=0. 024); as well as of portal vein flow: t0 vs t1-728.96Â405.56 vs 372.88Â166.70ml/min (p =0.018); there were no significant changes in other groups. There were no changes among the groups regarding superior mesenteric vein diameter, blood flow, and maximum flow velocity. The colonoscopic findings: telangiectasia and increased vascularisation were present (100%) in all groups. Angiodysplasia-like lesions, focal hyperemia and rectal varices although present, also did not reach significant difference among the groups. In the histology there was a trend to an increased inflammatory infiltrate in the colon in the preoperative (t 0 -72.7% vs t 1 â 30.0%) - (p=0.086). There was no difference in the mucosa changes as regard to ectasia, hyperemia, and fibroplasia in the preoperative in all surgical time; or in Group II. There was reduction of blood vessels in the rectum, t0 vs t1 â 10.89 Â 3.10 vs 6.89Â1.83 (p=0. 011); in the sigmoid, t0 vs t1 â 9.44 Â 1.88 vs 6.55 Â 1.67 (p=0. 021); in the ascending colon, t0 vs t1 â 10.89 Â 3.26 vs 6.89Â2. 20(P=0. 038) and in the ileum, t0 vs t1 â 12.00 Â 3.90 vs 6.11 Â 1.76(p=0. 008). Positive correlation was obtained only among the diameter measurements, and portal vein flow with density of the vessels in the ascending colon (r=0.622 and r=0.6530; which was not observed in other colon segments. There was no relationship between endoscopic and Doppler ultrasound findings. In conclusion normalization of vascular changes and the colon was not achieved after decompression of the portal system, in the six month follow-up period. Although decrease of portal pressure was observed, this factor did not seem to interfere with the studied finding.

ASSUNTO(S)

portal hypertension portal hypertensive colopathy schistosomiasis mansoni splenectomy ultrassonografia doppler doppler ultrasonography esquistossomose mansÃnica esplenectomia cirurgia hipertensÃo portal

ACESSO AO ARTIGO

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